Improving Maternal and Newborn Health Using the HIV/AIDS Program Platform in Tanz

描述(申请人提供)：针对PAR-10-038，我们建议测试调整已建立的艾滋病毒/艾滋病项目支持平台以加强孕产妇和新生儿健康(MNH)服务是否将增加对这些服务的接受，从而改善HIV阴性和HIV阳性妇女及其新生儿的结局。NIAID的关键战略优先事项之一是通过使用转化研究来减少健康差距和改善健康。坦桑尼亚是东非最大的国家，艾滋病毒感染率为5.7%，是世界上孕产妇和新生儿死亡率最高的国家之一。在美国总统艾滋病紧急救援计划(PEPFAR)的支持下，坦桑尼亚在提供艾滋病毒服务方面取得了显著进展，仅在2009年就避免了7500名新生儿感染艾滋病毒。相比之下，扩大对降低孕产妇和新生儿死亡率所需的基本孕产妇和新生儿保健服务的吸收就不那么成功了。尽管存在明确的政策和指导方针，但坦桑尼亚只有不到一半的妇女和新生儿使用高质量的保健保健服务。我们的初步数据表明，服务利用率较低可能是由于服务质量较差。糟糕的服务质量反过来又会导致糟糕的健康结果。为了在同样脆弱的卫生系统中取得成功，艾滋病毒项目开创了一种创新的方法来升级基础设施，提供培训和质量保证，并与当地社区合作。这一最初为艾滋病毒项目制定的三管齐下的卫生系统支持战略是否可以扩大，以提高卫生保健服务的质量和接受度？尽管它与临床和公共卫生有关，但没有随机研究来回答这个问题。这项研究将使用严格的研究方法来确定在临床和公共卫生环境中扩展循证卫生服务的有效战略。我们建议进行一项整群随机研究，以检验这样一种假设，即采用艾滋病毒规划战略来加强MNH服务(MNH+)将提高坦桑尼亚妇女基本MNH和HIV服务的质量和利用率。这项研究将与坦桑尼亚卫生部、伊法卡拉健康研究所、国际艾滋病护理和治疗计划中心(ICAP)、避免产妇死亡和残疾计划联合进行。将根据基线特征将普瓦尼地区(坦桑尼亚东部)的12个卫生中心配对，并随机分配以接受支持，以提高卫生保健服务的质量和覆盖范围，或加入对照组。将通过对居住在干预和控制保健中心范围内的3000名妇女进行具有人口代表性的调查，评估人群对产前、分娩、产后、预防母婴传播和艾滋病毒护理的利用情况。将使用详细的设施数据、ICAP的监测框架和结构化的临床观察来跟踪干预措施的质量和实施程度的改善。了解艾滋病毒经验是否可用于孕产妇和新生儿保健，有助于将证据从床边转化到社区(T2翻译)，以挽救低收入国家的孕产妇和新生儿的生命。

DESCRIPTION (provided by applicant): In response to PAR-10-038, we propose to test whether adapting an established HIV/AIDS program support platform to strengthen maternal and newborn health (MNH) services will increase uptake of these services and thus improve outcomes for both HIV-negative and HIV-positive women and their newborns. One of NIAID's key strategic priorities is to reduce health disparities and improve health by using translational research. Tanzania, the largest country in East Africa, has an HIV prevalence of 5.7% and some of the highest maternal and neonatal mortality rates in the world. With the support of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Tanzania has made remarkable progress in providing HIV services, averting 7,500 newborn HIV infections in 2009 alone. In contrast, expanding uptake of basic maternal and newborn health (MNH) services needed to reduce maternal and newborn mortality has been less successful. Fewer than half of Tanzania's women and newborns utilize high-quality MNH services, despite the existence of well-defined policies and guidelines. Our preliminary data suggest that low service utilization may be due to poor quality of services. Poor quality of services in turn results in poor health outcomes. To succeed in the same weak health systems, HIV programs have pioneered an innovative approach to upgrade infrastructure, provide training and quality assurance, and work with local communities. Could this three-pronged health system support strategy originally developed for HIV programs be expanded to improve the quality and uptake of MNH services? Despite its clinical and public health relevance, there are no randomized studies to answer this question. This study will use rigorous research methods to define effective strategies for scaling evidence- based health services in clinical and public health settings. We propose to undertake a cluster-randomized study to test the hypothesis that adapting HIV program strategies to strengthen MNH services (MNH+) will increase quality and utilization of essential MNH and HIV services among Tanzanian women. The study will be done jointly with the Tanzania Ministry of Health, Ifakara Health Institute, the International Center for AIDS Care and Treatment Programs (ICAP), the Averting Maternal Death and Disability Program. Twelve health centers in Pwani Region (eastern Tanzania) will be paired on baseline characteristics and randomly allocated to receive support to improve the quality and reach of MNH services or join the control group. Population-level utilization of antenatal, delivery, postnatal, PMTCT and HIV care will be assessed using population- representative surveys of 3000 women living within the catchments of intervention and control health centers. Improvements in quality and extent of implementation of the intervention will be tracked using detailed facility data, using ICAP's monitoring frameworks, and structured clinical observation. Understanding whether the HIV experience can be leveraged for maternal and newborn health care can assist in the translation of evidence from bedside to the community (T2 translation) to save maternal and newborn lives in low-income countries.